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Biomedical subjects

Michael W Peterson

Publications and source records attributed to Michael W Peterson.

15 recordsLinked to original sources
PubMed2006

Reactivation histoplasmosis after treatment with anti-tumor necrosis factor alpha in a patient from a nonendemic area.

Histoplasma capsulatum (HC) is a thermally dimorphic ascomycete that is a significant cause of respiratory infections (>80%) in endemic areas (Midwest and southeast USA), but infections are rare in non-endemic areas. Most primary HC infections are subclinical or self-limited. While reactivation Histoplasmosis has been reported in the setting of immunosuppression, it remains unclear whether remote primary latent infection represents risk of endogenous reactivation after anti-tumor necrosis factor (TNF)-alpha therapy. We report a case of a patient who developed reactivation Histoplasmosis after receiving anti-TNF-alpha. To our knowledge, this is the first clear report of reactivation of "latent" Histoplasmosis after anti-TNF-alpha therapy.

Adult↗
PubMed2006

Prognostic value of low blood glucose at the presentation of E. coli bacteremia.

PURPOSE: Septicemia is the tenth leading cause of death in the United States, and Escherichia coli is the most common isolate in blood cultures. Low blood glucose is a known complication of sepsis. The prognostic role of low blood glucose in E. coli bacteremia is unknown. The study's objective was to identify the incidence of low blood glucose at the presentation of E. coli bacteremia and determine its influence on prognosis and outcome. SUBJECTS AND METHODS: A retrospective cohort study was conducted in university-affiliated community hospitals. Subjects were consecutive patients diagnosed with E. coli bacteremia between 1997 and 2003. We identified 1060 patients with documented E. coli bacteremia. We excluded 105 patients who were younger than 18 years old or pregnant. We recorded demographic characteristics, discharge diagnosis, and outcome. RESULTS: Among the 955 patients with E. coli bacteremia, the average age was 64+/-19.4 years. Overall, 4.6% had documented low blood glucose (blood glucose <70 mg/dL) at presentation. The incidence of low blood glucose was the same in diabetic and nondiabetic patients. Patients with low blood glucose had a 4.7 times higher risk of death compared to patients with non-low blood glucose. Race, age, sex, and diabetes had no influence on survival. Gastrointestinal and genitourinary sources for E. coli bacteremia were more commonly associated with low blood glucose (P <.001). The study was limited to E. coli-positive blood cultures and to the one hospital system. CONCLUSIONS: Low blood glucose is present at the onset of E. coli bacteremia in 4.6% of patients. This represents a potentially large number of patients because E. coli is the most common blood culture isolate. Low blood glucose predicts poor outcome, especially in patients with abnormal hepatic and renal function. Low blood glucose should be considered an early clinical sign of E. coli bacteremia and aggressive therapy should be instituted to potentially save lives.

Adult↗
PubMed2004

A randomized controlled trial of an information prescription for pediatric patient education on the Internet.

BACKGROUND: Information prescriptions (IPs) are prescriptions of specific, evidence-based information to manage health problems. OBJECTIVE: To determine whether a pediatrician-provided IP would change parents' attitudes/behaviors about using Internet health information resources. DESIGN, SETTING, AND PARTICIPANTS: We conducted a randomized controlled trial of parents visiting an academic general pediatric practice. Both groups received a preintervention paper survey and a telephone survey 2 to 3 weeks after their clinic visit. The intervention group was offered computer training and received the IP and training summary handout. RESULTS: Final groups included 100 control and 97 intervention subjects. Of all parents, 68.0% had used the Internet in the past 6 months for health information and 52.8% used it for children's health information. The intervention group used the Internet more for general health information (P =.05) and child health information (P<.001) than the control group. At follow-up, 51 (66.2%) of 77 Internet information resources used by the intervention group were prescribed by the pediatricians. Parents who used the IP (31 [32%] of 97 intervention parents) used the Internet for general health information (P<.001) and child health information (P =.001) more than nonusers. Compared with nonusers, IP users were more likely to state they would use the IP again in the future (P =.02) and had already recommended the IP to family or friends more than nonusers (P =.001). CONCLUSIONS: Parents of children in pediatric practices commonly use the Internet for general and children's health information. In this study, IPs were associated with specific parental attitude and behavior changes resulting in increased Internet utilization for general and child health information and for specific high-quality information resources. Pediatricians can implement IPs in their office.

Adult↗
PubMed2004

Medical students' use of information resources: is the digital age dawning?

PURPOSE: One of the many challenges clinicians face is applying growing medical knowledge to specific patients; however, there is an information gap between information needs and delivery. Digital information resources could potentially bridge this gap. Because most medical students are exposed to personal computers throughout their education, this study postulated that students may be more comfortable using computer-based information resources within clinical interactions. METHOD: In 2001, the authors monitored second-year medical students' use of a unique digital textbook, UpToDate, as they transitioned from preclinical to clinical years at the University of Iowa Roy J. and Lucille A. Carver College of Medicine. In 2002, at the end of their third year, students were surveyed about their preferred clinical information resources. RESULTS: Medical students rapidly adopted UpToDate as a clinical resource during their clinical clerkship as evidenced by a rapid growth in the electronic textbook's use. One hundred sixteen of a possible 154 students (75%) responded to the survey. More than 85% of respondents identified electronic sources as their primary resource (UpToDate 53%, MDConsult 33%; p <.001 when compared to paper resources). They also reported using the information resources on a daily basis and requiring less than 15 minutes to answer most of their clinical questions. CONCLUSIONS: This study clearly demonstrates that medical students embrace and use electronic information resources much more than has been reported among practicing clinicians. The current generation of students may be the leaders in a medical culture shift from paper to electronic resources.

Attitude of Health Personnel↗
PubMed2004

Computer-based testing: initial report of extensive use in a medical school curriculum.

BACKGROUND: Computer-based digital technology offers many opportunities in medical education. One type of digital technology, computer-based testing (CBT), has potentially wide application in undergraduate, graduate, and continuing medical education. DESCRIPTION: This articles describes the development of CBT in an undergraduate medical curriculum. EVALUATION: An early step in evaluating CBT is to be sure that the exam format is measuring the examinees' knowledge and not their comfort level or confidence with the technology. It is, therefore, important that the CBT reproduce or accommodate traditional test-taking behavior. CBT also provides for a number of enhancements not easily achieved with traditional paper-and-pencil exams. These include easier control and editing of exam items, better incorporation of testing into the learning environment using specific feedback, and enhancing the questions by incorporating multimedia. CBT does present some unique challenges in testing security, and this article discusses the approach to the security issues. In addition, before initiating CBT into a medical curriculum, the institution must understand the technical and infrastructure requirements for CBT. CONCLUSIONS: By providing a 5-year experience with CBT in the medical curriculum, this article hopes to facilitate discussions among medical educators in its appropriate application and evaluation.

Clinical Competence↗
PubMed2004

An evaluation of information-seeking behaviors of general pediatricians.

OBJECTIVE: Usage of computer resources at the point of care has a positive effect on physician decision making. Pediatricians' information-seeking behaviors are not well characterized. The goal of this study was to characterize quantitatively the information-seeking behaviors of general pediatricians and specifically compare their use of computers, including digital libraries, before and after an educational intervention. METHODS: General pediatric residents and faculty at a US Midwest children's hospital participated. A control (year 1) versus intervention group (year 2) research design was implemented. Eligible pediatrician pools overlapped, such that some participated first in the control group and later as part of the intervention. The intervention group received a 10-minute individual training session and handout on how to use a pediatric digital library to answer professional questions. A general medical digital library was also available. Pediatricians in both the control and the intervention groups were surveyed using the critical incident technique during 2 6-month time periods. Both groups were telephoned for 1- to 2-minute interviews and were asked, "What pediatric question(s) did you have that you needed additional information to answer?" The main outcome measures were the differences between the proportion of pediatricians who use computers and digital libraries and a comparison of the number of times that pediatricians use these resources before and after intervention. RESULTS: A total of 58 pediatricians were eligible, and 52 participated (89.6%). Participant demographics between control (N = 41; 89.1%) and intervention (N = 31; 70.4%) were not statistically different. Twenty pediatricians were in both groups. Pediatricians were slightly less likely to pursue answers after the intervention (94.7% vs 89.2%); the primary reason cited for both groups was a lack of time. The pediatricians were as successful in finding answers in each group (95.7% vs 92.7%), but the intervention group took significantly less time (8.3 minutes vs 19.6 minutes). After the intervention, pediatricians used computers and digital libraries more to answer their questions and spent less time using them. CONCLUSION: This study showed higher rates of physician questions pursued and answered and higher rates of computer use at baseline and after intervention compared with previous studies. Pediatricians who seek answers at the point of care therefore should begin to shift their information-seeking behaviors toward computer resources, as they are as effective but more time-efficient.

Computer User Training↗
PubMed2003

Patient use of the internet for information in a lung cancer clinic.

STUDY OBJECTIVES: To determine how frequently patients attending a lung cancer clinic use the Internet for their own health information, to determine whether there are demographic differences between Internet users and nonusers, and to determine how patients compare the quality of Internet information with other sources of lung cancer information. DESIGN: Sequentially administered patient questionnaire. One hundred eighty-four patients were surveyed, and 139 patients (75.5%) completed the questionnaire. SETTING: A multidisciplinary thoracic oncology clinic in a Midwestern University hospital. PATIENTS OR PARTICIPANTS: Patients attending the multidisciplinary thoracic oncology clinic over a 3-month period. MEASUREMENTS AND RESULTS: The Internet was the most commonly used nonphysician source of information among our patients. Sixteen percent of the patients sought information on the Internet, but 60% expressed interest in using the Internet for information. Users were on average of higher income level and educational attainment but did not differ from nonusers by community size. Internet users rated the quality of information available on the Internet of similar quality to information from all sources. CONCLUSIONS: Older patients are increasing using the Internet for self-education in lung cancer. While certain barriers continue to exist, patients from rural areas use the Internet to the same degree, as do patients from urban areas. Patients do, however, overrate the quality of information on the Internet.

Adult↗
PubMed2002

Phosphatidylinositol 3-kinase activity negatively regulates stability of cyclooxygenase 2 mRNA.

Human alveolar macrophages have both lipopolysaccharide (LPS)-induced and constitutive phosphatidylinositol 3-kinase (PI3K) activity. We observed that blocking PI3K activity increased release of prostaglandin E2 after LPS exposure, and increasing PI3K activity (interleukin-13) decreased release of prostaglandin E2 after LPS exposure. This was not because of an effect of PI3K on phospholipase 2 activity. PI3K inhibition resulted in an increase in cyclooxygenase 2 (COX2) protein, mRNA, and mRNA stability. PI3K negatively regulated activation of the p38 pathway (p38, MKK3/6, and MAPKAP2), and an active p38 was necessary for COX2 production. The data suggest that PI3K inhibition of p38 modulates COX2 expression via destabilization of LPS-induced COX2 mRNA.

Animals↗
PubMed2002

Oxidant-mediated increases in redox factor-1 nuclear protein and activator protein-1 DNA binding in asbestos-treated macrophages.

Alveolar macrophages have been implicated in the pathogenesis of a number of acute and chronic lung disorders. We have previously shown that normal human alveolar macrophages exhibit decreased DNA binding activity of the transcription factor, AP-1, compared with monocytes. Furthermore, this decrease in AP-1 DNA binding appears to be due to a decrease in the redox active protein, redox factor (Ref)-1. Ref-1 is an important redox regulator of a number of transcription factors, including NF-kappaB and AP-1. In this study we evaluated the role of asbestos, a prototypic model of chronic fibrotic lung disease, in Ref-1 expression and activity. We found that incubation with low concentrations of crocidolite asbestos (0.5-1.25 microg/cm(2)) resulted in an increase in nuclear Ref-1 protein after 5 min, with a persistent elevation in protein up to 24 h. Additionally, an increase in nuclear Ref-1 could be induced by treating the cells with an oxidant-generating stimulus (iron loading plus PMA) and inhibited by diphenyleneiodonium chloride, an inhibitor of NADPH oxidase. The asbestos-induced accumulation of nuclear Ref-1 was associated with an increase in AP-1 DNA binding activity. These findings suggest that an exposure associated with fibrotic lung disease, i.e., asbestos, modulates accumulation of nuclear Ref-1 in macrophages, and that this effect is mediated by an oxidant stimulus.

Animals↗
PubMed2002

FDG-PET imaging and the diagnosis of non-small cell lung cancer in a region of high histoplasmosis prevalence.

STUDY OBJECTIVE: Determine the sensitivity and specificity of [F-18]-fluorine-2-deoxy-D-glucose positron emission tomography (FDG-PET) in differentiating non-small cell lung cancer (NSCLC) from benign solitary pulmonary nodules (SPNs) in a region with a high endemic rate of histoplamosis. DESIGN: Prospective, clinical study. SETTING: University, tertiary referral hospital in the upper Mississippi River valley. PATIENTS: Ninety patients with SPNs. INTERVENTIONS: Independent interpretation of FDG-PET imaging, computed tomography and pathologic evaluation of the SPNs. MEASUREMENTS AND RESULTS: To detect malignant SPNs, FDG-PET imaging had a sensitivity of 93%, a specificity of 40%, a positive predictive value (PPV) of 88% and a negative predictive value (NPV) of 55%. CONCLUSIONS: In a region with a high prevalence of pulmonary fungal infection, FDG-PET is sensitive but has a low specificity and NPV for identifying NSCLC. In our study cohort, FDG-PET does not appear to reduce the need for SPN biopsies.

Adult↗
PubMed2002

Is that your final answer? Relationship of changed answers to overall performance on a computer-based medical school course examination.

BACKGROUND: Whether examinees benefit from the opportunity to change answers to examination questions has been discussed widely. PURPOSE: This study was undertaken to document the impact of answer changing on exam performance on a computer-based course examination in a second-year medical school course. METHODS: This study analyzed data from a 2 hour, 80-item computer delivered multiple-choice exam administered to 190 students (166 second-year medical students and 24 physician's assistant students). RESULTS: There was a small but significant net improvement in overall score when answers were changed: one student's score increased by 7 points, 93 increased by 1 to 4 points, and 38 decreased by 1 to 3 points. On average, lower-performing students benefited slightly less than higher-performing students. Students spent more time on questions for which they changed the answers and were more likely to change items that were more difficult. CONCLUSIONS: Students should not be discouraged from changing answers, especially to difficult questions that require careful consideration, although the net effect is quite small.

Computer-Assisted Instruction↗
PubMed2002

An evaluation of the quality and contents of asthma education on the World Wide Web.

STUDY OBJECTIVES: To measure the accessibility and quality of currently available asthma education World Wide Web sites using the following criteria: accessibility by readability, language, and download time; information quality based on inclusion of core educational concepts and compliance with Health On the Net (HON) principles; and utilization of innovative technology. DESIGN: Objective evaluation of 145 Web sites. MEASUREMENTS AND RESULTS: Four search engines or directories (Yahoo, HON, Alta Vista, and Healthfinder) were searched for "asthma, patient information." A maximum of 50 Web sites from each search engine or directory was evaluated. Only 90 of the 145 Web sites actually contained asthma educational material. The mean (+/- SD) time necessary to open each Web site on a 28.800-bits-per-second modem was 33.6 ( +/- 36.6) s. The mean number of graphics on the Web sites was 24.6 ( +/- 30.2) files per page. The educational material required a mean reading level beyond the 10th grade. Only nine Web sites contained multilingual asthma education material. The mean number of HON principles with which the Web sites conformed was 6.3 ( +/- 1.0) of 8 principles; 14 Web sites conformed to all the HON criteria. The average Web site contained 4.9 (+/- 2.5) of 8 core asthma educational concepts, and only 20 Web sites contained all 8 educational concepts. Very few Web sites utilized innovative educational technology. CONCLUSIONS: While patient asthma education Web sites are common, asthma educational material contains many accessibility barriers, is highly variable in quality and content, and takes little innovative use of technology. Patient educational material currently available on the World Wide Web fails to meet the information needs of patients.

Asthma↗
PubMedDate not supplied

An analysis of patient care questions asked by pediatricians at an academic medical center.

BACKGROUND: General pediatricians' information needs are not presently well characterized in the literature. OBJECTIVE: To characterize the patient care information needs of academic medical center pediatricians by collecting and classifying questions generated in clinical settings, allowing pediatric educators and authors to more effectively meet the needs of pediatricians. METHODS: A semistructured telephone survey of pediatric residents and faculty at a midwestern US academic medical center over two 6-month periods. The main outcome measures were number of questions asked, age ranges, pediatric subspecialties, and generic question types. RESULTS: A total of 607 pediatrician questions were collected. The infant age range generated the most questions (34.1%), and other age groups were almost equally distributed. The most common pediatric specialties were pharmacology (34.1%), infectious diseases (9.1%), neurology/neurosurgery (5.1%), allergy/pulmonary (4.6%), and neonatology (4.6%). The most common generic questions asked were "What is the dosage of drug X?" (18.0%), "What is the treatment for condition X?" (15.2%), and "What is condition X?" (13.5%). There were qualitative differences between resident and faculty groups. CONCLUSIONS: The information needs of academic medical center pediatricians can be assessed and potentially serve as a foundation for the development of common and digital educational information resources. Resident and faculty groups showed some qualitative differences. Pediatricians need drug-dosing information; clear condition definitions, including manifestation and clinical course descriptions; and physical finding and laboratory testing information. Educators and authors should highlight information concerning pharmacology and infectious diseases when developing educational and information resources.

Academic Medical Centers↗